A look at the normal development of Pointing and Reaching Gestures in 12-16-Month-Old Farsi-Speaking Children: A Longitudinal Study.

Objectives
Human beings can use gestures such as pointing and reaching to communicate with others before they have the ability to use verbal communication to produce speech. Given the importance of children's communication development and the key role of gestures development in communicating, the main purpose of this study was to analyze the normal development of pointing and reaching gestures and their relationship in 12-16-month-old children speaking Farsi.


Materials & Methods
In this prospective, observational and longitudinal study the gestures of 11 monolingual Farsi-speaking children (7 boys and 4 girls, from Oct 2015 to Jan 2017 in the homes of participants across Tehran, Iran) were evaluated via non-randomized sampling method. Child-mother interactions were videotaped monthly in a semi-structured context to capture the emergence and consistent use of targeted gestures. Afterward, the data were coded and statistically analyzed for this purpose Repetitive measured; independent t-test and Pearson correlation were used.


Results
The mean of the pointing gesture increased significantly from 12 to 16 months (P<0.05). However, this was not significant for the reaching gesture. Moreover, there was no relationship between pointing and reaching gestures.


Conclusion
Pointing gestures increase with age from 12-16 months in Farsi-speaking children. However, reaching gestures stay the same between 12-16 months of age. The study provided rich details of common gestures that children use to signal their intentions before verbal communication.


Introduction
Human beings are social creatures and have a strong tendency to communicate even in the first months of life. This communication can have different communicative functions such as behavior regulation, social interaction and joint attention (1)(2)(3). Infants use a variety of gestures to communicate with others. Gestures are movements of parts of the body, especially the hands or head to express a meaning or a need (2)(3)(4)(5). Children develop intentional communication around 8 to 9 months and they use gestures to meet their needs (6,7). Pointing is one of the main gestures which are extending the finger toward something (8). It enables the child to communicate with others before accessing the verbal skills (2,3). The pointing gesture is a tool to regulate other's behavior results from more primitive gestures known as reaching gesture (9)(10)(11)(12). Reaching gesture is extending a hand toward an object except grasping movements (8). "Most basically, infant's acts of pointing are underpinned by: i) motoric prerequisites for index finger extension toward external objects; ii) motivational prerequisites for communicating with others in various ways (e.g requesting things imperatively, or indicating them declaratively); and iii) social-cognitive prerequisites for following, directing, and sharing attention with others" (13).
According to classic theories, infants' motivation to point for others begin with their attempt to obtain out-of-reach objects, on the other hand, human beings' fine motor skills develop with increasing the age, and one of the main skills is Index finger extension adapted for pointing gesture. In other hand, by increasing the age, infants imitate their caregivers' pointing gestures for communication and learn to point for achieving their intentions.

Pointing and Reaching Gestures in 12-16-Month-Old Farsi-Speaking Children: A Longitudinal Study
Therefore, reaching gesture with the imperative function (e.g. Behavior regulation) converts to the pointing gesture with the same function by increasing the age, so decreasing of reaching and increasing of pointing gestures are expected (10,(12)(13)(14)(15)(16). Reaching gesture appears first in the development and is the most frequent gesture during the first year of life (17). According to most studies in various societies, pointing gesture increase in the second year of life, especially in 16-20 months of age (3,8,(18)(19)(20)(21)(22)(23) Therefore, the main purpose of this study was to examine and describe the frequency, developmental process, and relationships of pointing and reaching gestures in 12-16-month-old toddlers in Iran.

Materials & Methods
The study was conducted from Oct 2015 to Jan 2017 in the homes of participants across Tehran, Iran.
This was a prospective, observational and longitudinal study in which the gestures of 11 monolinguals (12-month) Farsi-speaking children

Pointing and Reaching Gestures in 12-16-Month-Old Farsi-Speaking Children: A Longitudinal Study
The data collection instruments included motherchild demographic inventory, ASQ, and handy cam.
Mother-child demographic inventory included general question (child's sex, birth order, medical history and mother education and age), the validity of the demographic questionnaire was evaluated through content validity using scientific resources and expert's opinion. The content validity of questionnaire was qualitatively determined. The questions were revised based on the 14 speechlanguage Pathologists and then were presented to the parents.
ASQ is the most widely used for developmental disorders determination given to mothers to be filled. The coded data were analyzed using SPSS ver. 22 (Chicago, IL, USA) and the descriptive statistics such as mean, and standard deviation. As the data were normal according to Shapiro-Wilk Test, analytic statistics such as repetitive measured (within-subject comparison), independent t-test was used.
In order to validate the coding system, 20% of the

Results
The demographic information of the participants is presented in Table 1.
The frequency of pointing and reaching gestures is shown in Table 2.

Appendix 1:
The designed toys in this study include: The designed toys Bubble blower, puppet, baby doll, balloon, hairbrush, cups, spoons, plates, pan, baby bottle, toothbrush, towel, book, blanket or facecloth for peek-a-boo. -Touch and tap, when index finger touches the referent-lifts off the referent and touches referent again.
-Whole hand touch Reaching -Reaching with one or both arms extended toward an object that is out of reach.
-Partial reach, when one or both arms are partially extended.
-Reach to take -Reach with open hand or opening and closing hand

Pointing and Reaching Gestures in 12-16-Month-Old Farsi-Speaking Children: A Longitudinal Study
Another purpose of this study was to determine the developmental process of pointing and reaching gestures. As illustrated in Table 2 and Figure 1 Table 3 and 4.
According to the Table 2 and Figure 1, the frequency of reaching gesture followed the upward trend monthly, and the findings from the repetitive measurement in two successive months revealed that there was no meaningful difference between the frequency means of reaching gestures.
Generally, the comparison of the month 12 with other months revealed that there was no significant  However, inter-examiner reliability was examined on the 20% of the samples by two examiners. The intra-class correlation coefficient (ICC) was 90% (0.9) in this evaluation.

Discussion
The main purpose of this study was to determine the Moreover, we found that although there is a subtle difference in pointing gesture between successive months, these changes are not statistically substantial. This is probably because of a short distance between evaluation sessions. A dramatic change in the pointing gestures during only one month of development is not expected. However, the mean frequency of the pointing gesture increased significantly from 13 to 14 months (P=0.012). This change might be because of mother's more inclination toward using pointing gestures during this age (7,50).
In addition to the pointing gesture, reaching gesture was also examined in this study.